Real-World Evaluation of Clinical Response and Long-Term Healthcare Resource Utilization Patterns Following Treatment with a Digital Therapeutic for Chronic Insomnia
Background and Objectives: This analysis evaluated insomnia severity and long-term impact on healthcare resource utilization (HCRU) and costs after treatment with Somryst[R] (previously called SHUTi), a digital therapeutic delivering cognitive behavioral therapy for insomnia (CBT-I). Methods: Change...
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| Veröffentlicht in: | ClinicoEconomics and outcomes research 2022-01, Vol.14, p.537-546 |
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| creator | Forma, Felicia Knight, Tyler G Thorndike, Frances P Xiong, Xiaorui Baik, Rebecca Velez, Fulton F Maricich, Yuri A Malone, Daniel C |
| description | Background and Objectives: This analysis evaluated insomnia severity and long-term impact on healthcare resource utilization (HCRU) and costs after treatment with Somryst[R] (previously called SHUTi), a digital therapeutic delivering cognitive behavioral therapy for insomnia (CBT-I). Methods: Change from baseline in insomnia severity index (ISI) score was assessed using last observed ISI score. A pre/post analysis of claims data was conducted, comparing HCRU in patients with self-identified sleep problems who successfully initiated the therapeutic (index date) between June 1, 2016 and December 31, 2018. Results: A total of 248 patients were analyzed (median age 56.5 years, 57.3% female, mean ISI score 19.13, 52.4% treated with sleep aid medications pre-index). After 9 weeks, mean ISI score declined by 37.2% from baseline (19.1 vs 12.0), 58.8% of patients achieved ISI responder status (ISI score improved by =>7; NNT: 1.7), and 26.6% of patients achieved insomnia remission (ISI score |
| doi_str_mv | 10.2147/CEOR.S368780 |
| format | Article |
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Methods: Change from baseline in insomnia severity index (ISI) score was assessed using last observed ISI score. A pre/post analysis of claims data was conducted, comparing HCRU in patients with self-identified sleep problems who successfully initiated the therapeutic (index date) between June 1, 2016 and December 31, 2018. Results: A total of 248 patients were analyzed (median age 56.5 years, 57.3% female, mean ISI score 19.13, 52.4% treated with sleep aid medications pre-index). After 9 weeks, mean ISI score declined by 37.2% from baseline (19.1 vs 12.0), 58.8% of patients achieved ISI responder status (ISI score improved by =>7; NNT: 1.7), and 26.6% of patients achieved insomnia remission (ISI score <8; NNT for remission: 3.8). After two-year follow-up, post-index events were reduced (compared to 2 years pre-index) for emergency department visits (-53%; IRR: 0.47; 95% CI 0.27, 0.82; P=0.008), hospiatizations (-21%; IRR: 0.79; 95% CI 0.46, 1.35; P=0.389) and hospital outpatient visits (-13%; IRR: 0.87; 95% CI 0.66, 1.14; P=0.315). Slightly increased rates were observed for ambulatory surgical center visits (2%; IRR: 1.02; 95% CI 0.73, 1.44; P=0.903) and office visits (2%; IRR: 1.02; 95% CI 0.92, 1.14; P=0.672). The number of patients treated with sleep aid medications dropped 18.5% (52.4% pre-index vs 42.7% post-index). Average number of prescriptions decreased from 3.98 pre-index to 3.73 post-index (P= 0.552). Total two-year cost reduction post-index vs pre-index was $510,678, or -$2059 per patient. Conclusion: In a real-world cohort of patients with chronic insomnia, treatment with a digital therapeutic delivering CBT-I was associated with reductions in insomnia severity, emergency department visits, and net costs. Keywords: CBT-I, cognitive behavioral therapy for insomnia, chronic insomnia, prescription digital therapeutic, SHUTi, Somryst</description><identifier>ISSN: 1178-6981</identifier><identifier>EISSN: 1178-6981</identifier><identifier>DOI: 10.2147/CEOR.S368780</identifier><identifier>PMID: 35983014</identifier><language>eng</language><publisher>Macclesfield: Dove Medical Press Limited</publisher><subject>Alzheimer's disease ; Behavior ; Behavioral health care ; Care and treatment ; Cognitive behavioral therapy ; Cognitive therapy ; COVID-19 ; Diaries ; Evidence-based medicine ; Health aspects ; Health care ; Health care expenditures ; Insomnia ; Medicaid ; Medical care ; Medicare ; Original Research ; Patients ; Remission (Medicine) ; Review boards ; Sleep ; Software ; Surgical clinics ; Utilization</subject><ispartof>ClinicoEconomics and outcomes research, 2022-01, Vol.14, p.537-546</ispartof><rights>COPYRIGHT 2022 Dove Medical Press Limited</rights><rights>2022. This work is licensed under https://creativecommons.org/licenses/by-nc/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 Forma et al. 2022 Forma et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c487t-1ba0e0cbc2ef11a7d7a797a13fb2c578748e80137ee0a655240a9480392d6bbf3</citedby><cites>FETCH-LOGICAL-c487t-1ba0e0cbc2ef11a7d7a797a13fb2c578748e80137ee0a655240a9480392d6bbf3</cites><orcidid>0000-0001-7838-4524 ; 0000-0001-9054-5933</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379126/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9379126/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,3862,27924,27925,53791,53793</link.rule.ids></links><search><creatorcontrib>Forma, Felicia</creatorcontrib><creatorcontrib>Knight, Tyler G</creatorcontrib><creatorcontrib>Thorndike, Frances P</creatorcontrib><creatorcontrib>Xiong, Xiaorui</creatorcontrib><creatorcontrib>Baik, Rebecca</creatorcontrib><creatorcontrib>Velez, Fulton F</creatorcontrib><creatorcontrib>Maricich, Yuri A</creatorcontrib><creatorcontrib>Malone, Daniel C</creatorcontrib><title>Real-World Evaluation of Clinical Response and Long-Term Healthcare Resource Utilization Patterns Following Treatment with a Digital Therapeutic for Chronic Insomnia</title><title>ClinicoEconomics and outcomes research</title><description>Background and Objectives: This analysis evaluated insomnia severity and long-term impact on healthcare resource utilization (HCRU) and costs after treatment with Somryst[R] (previously called SHUTi), a digital therapeutic delivering cognitive behavioral therapy for insomnia (CBT-I). Methods: Change from baseline in insomnia severity index (ISI) score was assessed using last observed ISI score. A pre/post analysis of claims data was conducted, comparing HCRU in patients with self-identified sleep problems who successfully initiated the therapeutic (index date) between June 1, 2016 and December 31, 2018. Results: A total of 248 patients were analyzed (median age 56.5 years, 57.3% female, mean ISI score 19.13, 52.4% treated with sleep aid medications pre-index). After 9 weeks, mean ISI score declined by 37.2% from baseline (19.1 vs 12.0), 58.8% of patients achieved ISI responder status (ISI score improved by =>7; NNT: 1.7), and 26.6% of patients achieved insomnia remission (ISI score <8; NNT for remission: 3.8). After two-year follow-up, post-index events were reduced (compared to 2 years pre-index) for emergency department visits (-53%; IRR: 0.47; 95% CI 0.27, 0.82; P=0.008), hospiatizations (-21%; IRR: 0.79; 95% CI 0.46, 1.35; P=0.389) and hospital outpatient visits (-13%; IRR: 0.87; 95% CI 0.66, 1.14; P=0.315). Slightly increased rates were observed for ambulatory surgical center visits (2%; IRR: 1.02; 95% CI 0.73, 1.44; P=0.903) and office visits (2%; IRR: 1.02; 95% CI 0.92, 1.14; P=0.672). The number of patients treated with sleep aid medications dropped 18.5% (52.4% pre-index vs 42.7% post-index). Average number of prescriptions decreased from 3.98 pre-index to 3.73 post-index (P= 0.552). Total two-year cost reduction post-index vs pre-index was $510,678, or -$2059 per patient. Conclusion: In a real-world cohort of patients with chronic insomnia, treatment with a digital therapeutic delivering CBT-I was associated with reductions in insomnia severity, emergency department visits, and net costs. Keywords: CBT-I, cognitive behavioral therapy for insomnia, chronic insomnia, prescription digital therapeutic, SHUTi, Somryst</description><subject>Alzheimer's disease</subject><subject>Behavior</subject><subject>Behavioral health care</subject><subject>Care and treatment</subject><subject>Cognitive behavioral therapy</subject><subject>Cognitive therapy</subject><subject>COVID-19</subject><subject>Diaries</subject><subject>Evidence-based medicine</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Health care expenditures</subject><subject>Insomnia</subject><subject>Medicaid</subject><subject>Medical care</subject><subject>Medicare</subject><subject>Original Research</subject><subject>Patients</subject><subject>Remission (Medicine)</subject><subject>Review boards</subject><subject>Sleep</subject><subject>Software</subject><subject>Surgical clinics</subject><subject>Utilization</subject><issn>1178-6981</issn><issn>1178-6981</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNptkt9uFCEUxidGY5vaOx-AxMR44aww_2BuTJrp1jbZpGbdxkvCsGd2aBhYgWmjT9NLn6NPJuNutGuECwj8vu_AOSdJXhM8y0hBPzTz6-XsS14xyvCz5JgQytKqZuT5k_1Rcur9LY6jqPOM1S-To7ysWY5JcZz8XILQ6Vfr9PrxYX4n9CiCsgbZDjVaGSWFRkvwW2s8IGEitLBmk67ADegySkMvhYMJsaOTgG6C0urHzuOzCAGc8ejCam3vldmglQMRBjAB3avQI_H4cK42KsQgqx6c2MIYlESddajpnY3h0ZXxdjBKvEpedEJ7ON2vJ8nNxXzVXKaL609XzdkilQWjISWtwIBlKzPoCBF0TQWtqSB512aypIwWDBgmOQXAoirLrMCiLhjO62xdtW2XnyQfd77bsR1gLeNbndB869Qg3HduheKHN0b1fGPveJ3TmmRVNHi3N3D22wg-8EF5CVoLA3b0PKO4YFVd1DSib_5Bb2MWTfzeRGU0zyglf6mN0MCV6WyMKydTfkYJI7gsyoma_YeKcw2DktZAp-L5geDtE0H_u5be6nEqnT8E3-9A6az3Dro_ySCYT13Ipy7k-y7MfwEMt9Gk</recordid><startdate>20220101</startdate><enddate>20220101</enddate><creator>Forma, Felicia</creator><creator>Knight, Tyler G</creator><creator>Thorndike, Frances P</creator><creator>Xiong, Xiaorui</creator><creator>Baik, Rebecca</creator><creator>Velez, Fulton F</creator><creator>Maricich, Yuri A</creator><creator>Malone, Daniel C</creator><general>Dove Medical Press Limited</general><general>Taylor & Francis Ltd</general><general>Dove</general><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7XB</scope><scope>8C1</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-7838-4524</orcidid><orcidid>https://orcid.org/0000-0001-9054-5933</orcidid></search><sort><creationdate>20220101</creationdate><title>Real-World Evaluation of Clinical Response and Long-Term Healthcare Resource Utilization Patterns Following Treatment with a Digital Therapeutic for Chronic Insomnia</title><author>Forma, Felicia ; Knight, Tyler G ; Thorndike, Frances P ; Xiong, Xiaorui ; Baik, Rebecca ; Velez, Fulton F ; Maricich, Yuri A ; Malone, Daniel C</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c487t-1ba0e0cbc2ef11a7d7a797a13fb2c578748e80137ee0a655240a9480392d6bbf3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Alzheimer's disease</topic><topic>Behavior</topic><topic>Behavioral health care</topic><topic>Care and treatment</topic><topic>Cognitive behavioral therapy</topic><topic>Cognitive therapy</topic><topic>COVID-19</topic><topic>Diaries</topic><topic>Evidence-based medicine</topic><topic>Health aspects</topic><topic>Health care</topic><topic>Health care expenditures</topic><topic>Insomnia</topic><topic>Medicaid</topic><topic>Medical care</topic><topic>Medicare</topic><topic>Original Research</topic><topic>Patients</topic><topic>Remission (Medicine)</topic><topic>Review boards</topic><topic>Sleep</topic><topic>Software</topic><topic>Surgical clinics</topic><topic>Utilization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Forma, Felicia</creatorcontrib><creatorcontrib>Knight, Tyler G</creatorcontrib><creatorcontrib>Thorndike, Frances P</creatorcontrib><creatorcontrib>Xiong, Xiaorui</creatorcontrib><creatorcontrib>Baik, Rebecca</creatorcontrib><creatorcontrib>Velez, Fulton F</creatorcontrib><creatorcontrib>Maricich, Yuri A</creatorcontrib><creatorcontrib>Malone, Daniel C</creatorcontrib><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Public Health Database</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>ClinicoEconomics and outcomes research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Forma, Felicia</au><au>Knight, Tyler G</au><au>Thorndike, Frances P</au><au>Xiong, Xiaorui</au><au>Baik, Rebecca</au><au>Velez, Fulton F</au><au>Maricich, Yuri A</au><au>Malone, Daniel C</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Real-World Evaluation of Clinical Response and Long-Term Healthcare Resource Utilization Patterns Following Treatment with a Digital Therapeutic for Chronic Insomnia</atitle><jtitle>ClinicoEconomics and outcomes research</jtitle><date>2022-01-01</date><risdate>2022</risdate><volume>14</volume><spage>537</spage><epage>546</epage><pages>537-546</pages><issn>1178-6981</issn><eissn>1178-6981</eissn><abstract>Background and Objectives: This analysis evaluated insomnia severity and long-term impact on healthcare resource utilization (HCRU) and costs after treatment with Somryst[R] (previously called SHUTi), a digital therapeutic delivering cognitive behavioral therapy for insomnia (CBT-I). Methods: Change from baseline in insomnia severity index (ISI) score was assessed using last observed ISI score. A pre/post analysis of claims data was conducted, comparing HCRU in patients with self-identified sleep problems who successfully initiated the therapeutic (index date) between June 1, 2016 and December 31, 2018. Results: A total of 248 patients were analyzed (median age 56.5 years, 57.3% female, mean ISI score 19.13, 52.4% treated with sleep aid medications pre-index). After 9 weeks, mean ISI score declined by 37.2% from baseline (19.1 vs 12.0), 58.8% of patients achieved ISI responder status (ISI score improved by =>7; NNT: 1.7), and 26.6% of patients achieved insomnia remission (ISI score <8; NNT for remission: 3.8). After two-year follow-up, post-index events were reduced (compared to 2 years pre-index) for emergency department visits (-53%; IRR: 0.47; 95% CI 0.27, 0.82; P=0.008), hospiatizations (-21%; IRR: 0.79; 95% CI 0.46, 1.35; P=0.389) and hospital outpatient visits (-13%; IRR: 0.87; 95% CI 0.66, 1.14; P=0.315). Slightly increased rates were observed for ambulatory surgical center visits (2%; IRR: 1.02; 95% CI 0.73, 1.44; P=0.903) and office visits (2%; IRR: 1.02; 95% CI 0.92, 1.14; P=0.672). The number of patients treated with sleep aid medications dropped 18.5% (52.4% pre-index vs 42.7% post-index). Average number of prescriptions decreased from 3.98 pre-index to 3.73 post-index (P= 0.552). Total two-year cost reduction post-index vs pre-index was $510,678, or -$2059 per patient. Conclusion: In a real-world cohort of patients with chronic insomnia, treatment with a digital therapeutic delivering CBT-I was associated with reductions in insomnia severity, emergency department visits, and net costs. Keywords: CBT-I, cognitive behavioral therapy for insomnia, chronic insomnia, prescription digital therapeutic, SHUTi, Somryst</abstract><cop>Macclesfield</cop><pub>Dove Medical Press Limited</pub><pmid>35983014</pmid><doi>10.2147/CEOR.S368780</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-7838-4524</orcidid><orcidid>https://orcid.org/0000-0001-9054-5933</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | ClinicoEconomics and outcomes research, 2022-01, Vol.14, p.537-546 |
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| source | Taylor & Francis Open Access; DOVE Medical Press Journals; DOAJ Directory of Open Access Journals; PubMed Central Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Alzheimer's disease Behavior Behavioral health care Care and treatment Cognitive behavioral therapy Cognitive therapy COVID-19 Diaries Evidence-based medicine Health aspects Health care Health care expenditures Insomnia Medicaid Medical care Medicare Original Research Patients Remission (Medicine) Review boards Sleep Software Surgical clinics Utilization |
| title | Real-World Evaluation of Clinical Response and Long-Term Healthcare Resource Utilization Patterns Following Treatment with a Digital Therapeutic for Chronic Insomnia |
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